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- W2920283032 abstract "A 60-year-old Japanese man who had been treated with metronidazole (1000 mg/day) for splenic abscesses diagnosed 85 days earlier was transferred to our department because of convulsive seizures and impaired consciousness. He did not consume alcohol and his medical history included the treatment of rheumatoid arthritis with prednisolone and iguratimod for the past 6 years. On admission, his Glasgow Coma Scale score was E4V4M6 and his body temperature was 36.8°C. Neurological examination showed no signs of cerebellar dysfunction. A brain MRI fluid-attenuated inversion-recovery (FLAIR) image revealed hyperintensities in the cerebellar dentate nucleus (CDN) (figure 1). He was subsequently diagnosed with metronidazole-induced encephalopathy (MIE) and his symptoms improved after the immediate discontinuation of metronidazole. Metronidazole is an effective antibiotic for a range of protozoal and anaerobic infections, but in rare cases can cause MIE.1 2 The median duration of this toxicity is 19 days (range, 1–180 days)3 and the average cumulative dose is 93.4 g (range, 0.25–1095 g).4 Symptoms associated with MIE include cerebellar symptoms (48%), psychosis (24%) and seizures (10%).3 The characteristic MRI findings are T2/FLAIR hyperintensities in the CDN.1 2 MIE symptoms typically improve after discontinuation of metronidazole, but in rare cases they can actually irreversibly progress, resulting in death.1 Clinicians should therefore consider MIE in the differential diagnosis of convulsive seizures with a history of metronidazole treatment even if patients have no cerebellar symptoms, and investigate potential lesions in the CDN using MRI." @default.
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- W2920283032 date "2019-03-04" @default.
- W2920283032 modified "2023-09-25" @default.
- W2920283032 title "Convulsive seizures caused by metronidazole-induced encephalopathy" @default.
- W2920283032 cites W2007072192 @default.
- W2920283032 cites W2283304113 @default.
- W2920283032 doi "https://doi.org/10.1136/postgradmedj-2018-136353" @default.
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